Efficient and Effective Use of EHRs

Office of the National Coordinator for Health Information Technology (ONC) and the Agency for Healthcare Research and Quality (AHRQ) want to have a process for measuring and evaluating the usability of health IT systems

The proposed certification criteria are called: 2014 Edition EHR certification criteria

These certification criteria seek to enhance care coordination, patient and family engagement, interoperability, and the security, safety, and efficacy of EHR technology  (The permanent certification program will be called ONC HIT Certification Program)

A new criterion for EHR certification is called 'safety-enhanced design.' This is a smart move, since everyone agrees on improving patient safety. You've probably read that medical error is a leading cause of death in the US, some say it's in fifth place at 98,000 deaths each year.

"We believe that a significant first step toward improving overall usability is to focus on the process of UCD"

but limited to eight certification criteria:

• § 170.314(a)(1) (CPOE);

• § 170.314(a)(2) (Drug-drug, drug-allergy interaction checks);

• § 170.314(a)(6) (Medication list);

• § 170.314(a)(7) (Medication allergy list);

• § 170.314(a)(8) (Clinical decision support);

• § 170.314(a)(17) (Electronic medication administration record);

• § 170.314(b)(3) (Electronic prescribing); and

• § 170.314(b)(4) (Clinical information reconciliation)

These eight areas are responsible for the most errors and offer the greatest opportunity for preventing errors and improving the users' experience with EHRs.

While there is no singular model of UCD, the instantiations embody the following principles:

    • Understand user needs, workflows and work environments
    • Engage users early and often
    • Set user performance objectives
    • Design the user interface from known human behavior principles and familiar user interface models
    • Conduct usability tests to measure how well the interface meets user needs
    • Adapt the design and iteratively test with users until performance objectives are met

Surprisingly, the proposed rule lets EHR vendors choose the specific UCD process(es) they will follow. This is the big fault. One EHR vendor could use just one UCD process, say understanding user needs, while another EHR vendor could use several UCD processes (usability testing, contextual inquiry, iterative design changes, designing with usability best practices, summative usability testing, and employing a usability standard). Both would meet the certification criterion. It's a pass-fail test. And if a vendor does anything, they pass. Imagine a student attending a physics class and choosing just one assignment to complete and passing the course. Not the engineer I want designing bridges, if you catch my drift.

Vendors could provide documentation showing that they have been following UCD processes. That counts as a pass for this criterion. Other vendors who had not been following UCD processes would have to prove that they had been using them before they could be certified.

Surprisingly enough, the results of any usability testing used for certification would be publicly available. That will certainly get the attention of EHR vendors who want to keep proprietary information private, and avoid opening their kimonos to the world.

Watch for screams from EHR vendors on the results of usability testing. But if that's the only requirement to be removed from the proposed rule, then it's a win for physicians and consumers. We still get a user-centered design methodology.  Perhaps usability scores for EHRs are not so far away.

courtesy of Consumer Reportsconsumer reports rating symbols

About Fairfield Professionals

Fairfield Professionals is an IT management consulting firm specializing in the creation, selection and enhancement of easy-to-learn systems resulting in faster user adoption, higher conversion rates, improved productivity, efficiency and accuracy. Fairfield Professionals utilizes user-centered design, market-centric product management and multi-disciplinary team management with startup and Fortune 500 organizations.


"Deal with the world the way it is, not the way you wish it was." John Chambers
"We need some ability which allows us to envision the objective from afar, and this ability is intuition." Henri Poincare
"In order to have judgment, you have to have knowledge and experience." - Nancy Pelosi (D, California)
"If you're building a product or delivering a service that solves a real problem, you can do well and grow fast." Marina Hatsopoulos
"You already know the answers. You just don't want to hear them from yourself." - Sunny Vanderbeck
Go to top